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Table 1 Patient characteristics, ICI treatment history, symptomatology, and endoscopy findings

From: Concurrent therapy with immune checkpoint inhibitors and TNFα blockade in patients with gastrointestinal immune-related adverse events

Patient Age Sex Malignancy History of other ICI exposure ICI type and dose Days (doses) to onset of symptoms post ICI Diarrhea grade Other symptoms Colitis grade Endoscopic features Histopathologic features
1 75 M Meningioma None Pembrolizumab
Dose: 3 mg/kg
Frequency: every 3 weeks
39 days (2) 1 None 2 Colonoscopy:
Sigmoid colon: localized moderate inflammation characterized by altered vascularity, congestion (edema), friability and granularity
Colonoscopy:
- Ileum: mucosa with hyperplastic Peyer’s patches and no diagnostic abnormality
- Ascending colon: mucosa with lymphoid aggregate and no diagnostic abnormality
- Sigmoid colon: moderately active colitis with neutrophilic cryptitis and crypt abscesses
2 58 F Colon - Pembrolizumab (stopped 2 years prior to current ICI): no adverse effects but disease progression Ipilimumab/Nivolumab
Dose:
Ipilimumab-1 mg/kg, Nivolumab- 240 mg (3 mg/kg)
Frequency: combined every 6 weeks (4 doses total) followed by nivolumab alone every 2 weeks
8 days (1) 2 Abdominal pain 2 Upper endoscopy:
- Gastric antrum: diffuse moderately erythematous mucosa without bleeding
- Duodenum: an acquired benign-appearing, intrinsic moderate stenosis in the first portion of the duodenum
Upper endoscopy:
- Gastric antrum/fundus/body:
active chronic gastritis
- Duodenum: mucosa with ulceration, crypt dropout, marked expansion of lamina propria with prominent eosinophils and acute inflammation
- Duodenal stricture: mucosa with mild expansion of the lamina propria
3 70 F Melanoma - PD-L1 inhibitor (as a part of a clinical trial): for a total of 1 year (stopped 3 years prior to current ICI). No adverse events but disease recurrence
- Pembrolizumab: 200 mg 3 (mg/kg) every 3 weeks for total of 8 doses (stopped 1 year prior to current ICI): no adverse events but disease progression
Ipilimumab
Dose: 3 mg/kg
Frequency: every 3 weeks
35 days (2) 2 Nausea, vomiting 2 Upper Endoscopy:
- Stomach: normal
- Duodenum: diffuse moderately scalloped mucosa
Flexible Sigmoidoscopy:
- Colon: examined portion was normal
Upper Endoscopy:
- Duodenum: diffuse active duodenitis with villous blunting, expansion of the lamina propria with mixed inflammation, and reactive epithelial changes
- Stomach: antral mucosa with edema and mild patchy inflammation
Flexible Sigmoidoscopy:
- Colon: normal
4 73 M Melanoma Atezolizumab (in combination with cobimetinib): total of 13 cycles (stopped 2 weeks prior to current ICI) Ipilimumab/Nivolumab
Dose:
Ipilimumab-3 mg/kg, Nivolumab-1 mg/kg
Frequency: combined every 3 weeks
11 days (1) 2 Nausea, vomiting, abdominal pain 2 Upper Endoscopy:
- Stomach: non-bleeding erosive gastropathy
- Duodenum: diffuse mildly congested mucosa without active bleeding
Colonoscopy:
- Sigmoid and descending colon: discontinuous areas of nonbleeding ulcerated mucosa with no stigmata of recent bleeding
Upper Endoscopy:
- Stomach: active gastritis with small stromal granuloma in antrum. Active gastritis with stromal histiocytes in the body
- Duodenum: active duodenitis with villous injury
Colonoscopy:
- Descending colon: focal active colitis with stromal histiocytes
- Colon and sigmoid ulcers: severely active colitis with ulceration
5 79 F SCC None Cemiplimab
Dose: 350 mg
Frequency: every 3 weeks
14 (1 dose) 1 Nausea, vomiting 2 Upper Endoscopy:
- Stomach: Non-bleeding erosive gastropathy
- Duodenum: normal
Flexible Sigmoidoscopy:
- Colon: Inflammation characterized by congestion (edema), erythema and granularity
Upper Endoscopy:
- Stomach: reactive gastropathy and intestinal metaplasia
- Duodenum: normal
Flexible Sigmoidoscopy:
- Colon: mucosa with mildly increased cellularity of the lamina propria and epithelial injury. Focal acute inflammation is also noted, but there is no increase in apoptosis.